We had an extensive discussion about upper eyelid blepharoplasty, also called upper lid surgery or upper eyelid lift. This procedure removes excess skin and, when needed, adjusts small fat pads to create a more alert, youthful, and refreshed appearance. Heavy upper lids can make you look tired or sad and, in severe cases, can obstruct peripheral vision.
Understanding Upper Eyelid Aging
- Skin excess: The upper eyelid skin stretches and creates hooding.
- Fat prolapse: Upper lid fat pads can bulge forward, especially near the inner corner.
- Elasticity loss: Skin becomes less resilient over time.
- Brow descent contribution: A low brow can push tissue onto the eyelid, worsening hooding.
The Critical Role of Brow Position
Before upper eyelid surgery, brow position must be evaluated. If brow droop is the main issue and only eyelid skin is removed, improvement may be limited and the eyes can look hollow or overly operated. Many patients benefit from a brow lift, upper blepharoplasty, or both. Your anatomy guides the right choice.
Upper Eyelid Blepharoplasty Technique
Incision Design
The incision is measured and marked while you are upright. It follows the natural eyelid crease so the scar heals in a hidden location. The incision widens slightly toward the outer lid where more excess skin tends to collect.
Tissue Removal and Contouring
- Skin excision: A carefully measured ellipse of skin is removed. Conservative removal is essential to allow smooth lid closure.
- Fat management: If fat pads are prolapsed, they are reduced conservatively or repositioned. The goal is a smooth contour without creating a hollow look.
Closure
The incision is closed with fine sutures that are removed in 5 to 7 days. As healing progresses, the scar becomes barely visible.
Goals of Surgery
- Remove hooding while keeping a natural lid shape
- Preserve enough skin so the eye closes comfortably
- Maintain a soft youthful upper lid fullness
- Create a rested, refreshed appearance without looking “done”
Functional Considerations
If upper lid skin blocks the upper visual field, blepharoplasty can improve vision. In those cases, visual field testing can sometimes justify insurance coverage, although I do not participate with insurance. If this applies to you, I can guide you toward appropriate documentation and referrals.
Recovery From Upper Blepharoplasty
- First few days: Mild tightness, swelling, and bruising. Cold compresses help.
- 5 to 7 days: Sutures removed.
- 1 week: Many patients return to work in 3 to 5 days.
- 2 weeks: Bruising usually resolves.
- 3 to 6 months: Final contour and scar refinement become clear.
Avoid contact lenses and eye makeup for about 1 to 2 weeks, and avoid heavy exercise for 2 weeks.
Combining With Other Procedures
Upper blepharoplasty is commonly combined with brow lift, lower blepharoplasty, facelift, neck lift, fat grafting, or skin resurfacing to create balanced facial rejuvenation with one recovery.
Setting Realistic Expectations
- You will look like yourself, just more rested.
- Natural asymmetries remain.
- Crow’s feet are not removed by blepharoplasty.
- Blepharoplasty does not lift brows.
- Results are long lasting, often 10 to 15 years.
Potential Risks and Complications
- Bleeding or hematoma
- Infection
- Asymmetry
- Inadequate or excessive skin removal
- Temporary dry eyes or incomplete closure
- Visible scarring (rare with good crease placement)
- Hollow appearance from over-resection of fat
Conservative technique and careful planning minimize these risks.
Making the Decision
Upper eyelid blepharoplasty can provide a dramatic improvement in a tired or heavy-lidded look. The key is proper evaluation of brow position, conservative tissue removal, and a plan that fits your anatomy and goals.
Photos were obtained, a quote was given, and the patient will return in a week for further discussions if needed.
